Dentistry/Extraction and simultaneous grafting

QuestionQUESTION: Dear Dr., I am scheduled for 2 extractions (19&30) in about 2 weeks. The tops of the teeth have cracked off and dentin disintegrated. They are both infected now and have been for over a year. Surgeon says he has to surgically remove them because there is no top to pull on. I went to 2 dentists last summer (several abscesses), but was afraid to have teeth pulled. No one ever even hinted at antibiotics. Now, the oral surgeon wants to remove both teeth and do bone grafting at the same time. What about infection? Having had these infections for so long, I don't think they are just going to disappear when the teeth are pulled. Don't you want to make sure all infection is gone and healing nicely before you graft over the holes? I agreed the other day at the office to do bone graft simultaneously, but now am changing my mind due to fear of a remaining infection. I'll have to let the oral surgeon know that I would prefer to just have teeth pulled at this time. What do you think? My long term plan was to get implants, but I want to heal and progress healthfully. Can you comment, please? Thank you very much!

ANSWER: Dear Mark,

Almost always, infections that are caused by teeth, go away after the infected teeth are remomed.

Having said that, the purpose of bone grafting into an extraction site is to preserve the height and width of the jawbone for future use, like for implant or denture. As long as antibiotic is given and taken after the bone graft, grafts into extraction sites do their job more than 96% of the time. Plus the bone graft material provides protection to vital tissues that surround the tooth roots (mandibular nerve on the lower. Sinuses on the upper).

In addition, a bone graft placed now will save you an additional surgical entry later, and will save you dollars because of this.

As much as you say you are concerned with healing healthfully, you allowed known abscesses to fester and expand for months. If you were really concerned, you would have had these teeth removed then.

I think you should take your oral surgeon's advice.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr., Just a simple follow up question. At my visit, the surgeon's nurse prescribed the antibiotic azithromycin(Z pak). We discussed my extreme sensitivity to antibiotics in general, and that's why she suggested this one. However, I checked reviews on-line and it was stated repeatedly that this particular drug can cause problems to someone with kidney or liver problems. I do not have problems with these organs, but just the fact that it was mentioned that these organs can be affected, might lead one to want to protect his healthy kidneys and liver from any risk. The articles also mentioned the possibility of the onset of colitis, even months after antibiotic has been discontinued. The Z pak dosage is only for one week; two on the day of surgery and one following each day for the next 5 consecutive days. That's it. No extended course of antibiotic use after that. Do you think this minimal approach is sufficient to protect against further infection. I asked the nurse and she said yes. The doctor had moved on to another patient by now and I couldn't ask him. I am going to ask the pharmacist at the store about the history of azithromycin. Can you comment on the effectiveness of this drug? Thank you very much, Dr. Finnk! Mark

AnswerOnce again, you are questioning the judgment of your surgeon.

Azythromycin is a very safe and effective antibiotic. So safe that it is becoming the go-to antibiotic for most doctors. It works. It is safe for those who are sensitive to penicillin. It has been packaged to be an antibiotic that is taken for a short period. If you are concerned with the fact that it will be taken for only 5 days, ask for a refill prescription.

All medicines can cause problems with liver or kidneys or colon or all of these. Neither I nor your surgeon can guarantee that this won't happen. On the other hand, you have been harboring infection in your jaw that can spread to your throat, your lungs, your stomach and your heart. Yet this does not seem to concern you as much as the procedures recommended to resolve your infections, or the after-treatment.

I know you are concerned with receiving proper care. The fact is that what your surgeon has recommended appears to be right for you. Although it can lead to complications, what you now have will surely lead to much worse complications. We all want the best of care. So far, you are heading down a road to no care. You will need to place your trust in your surgeon and let go of your fears. Remember, having the recommended procedures done will give you a 99% chance of a good result. Having nothing done will give you a 99% chance of having a bad result. Which do you choose?

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Education/CredentialsBachelor of Arts and Sciences in Psychology from Wayne State University
Doctor of Dental Surgery from University of Detroit College of Dentistry
Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and HonorsMembership in The Vedder Honors Society

Past/Present ClientsHIPAA rules do not allow me to post this information.